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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (06): 357 -361. doi: 10.3877/cma.j.issn.1674-6899.2020.06.009

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腹腔镜辅助下Overlap法管型胃食管吻合在食管胃结合部腺癌中临床疗效分析
李东亮 1, 王伟 2, 周家杰 3, 杜瑞 3, 王峰 3, 佟贵繁 3, 丁旭 1, 汪刘华 2, 汤东 2, 王道荣 2 , †( )   
  1. 1. 225000 扬州大学医学院
    2. 225001 扬州，江苏省苏北人民医院，扬州大学临床医学院，扬州大学-扬州市普通外科研究所
    3. 116044 大连医科大学研究生院
  • 收稿日期:2020-09-21 出版日期:2020-12-30
  • 通信作者: 王道荣

Laparoscopic-assisted Overlap tube gastroesophageal anastomosis in the treatment of adenocarcinoma of the esophagogastric junction

Dongliang Li 1, Wei Wang 2, Jiajie Zhou 3, Rui Du 3, Feng Wang 3, Guifan Tong 3, Xu Ding 1, Liuhua Wang 2, Dong Tang 2, Daorong Wang 2 , †( )   

  1. 1. School of Medicine, Yangzhou University, Yangzhou 225000, China.
    2. Department of General Surgery, Subei People′s Hospital of Jiangsu Province, Clinical Medical College, Yangzhou University, Institute of General Surgery-Yangzhou University, Yangzhou 225001, China.
    3. Dalian Medical University, Dalian 116044, China
  • Received:2020-09-21 Published:2020-12-30
  • Corresponding author: Daorong Wang
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目的

探讨腹腔镜辅助下Overlap法管型胃食管吻合在Siewert Ⅱ型和Ⅲ型食管胃结合部腺癌(adenocarcinoma of the esophagogastfic junction，AEG)中临床应用疗效。

方法

回顾性分析江苏省苏北人民医院胃肠中心2018年1月至2020年4月30例行腹腔镜辅助下近端胃切除的Siewert Ⅱ型和Ⅲ型AEG患者临床资料。2019年5月以前的18例行传统食管胃吻合(A组)，2019年5月及以后的12例行Overlap法管型胃食管吻合(B组)。应用SPSS 19.0统计软件进行分析，患者的一般资料、围手术期指标及术后反流性疾病问卷表(reflux diagnostic questionnaire，RDQ)评分等计量资料以均数±标准差( ±s)表示，两两比较采用t检验；术后胃食管反流病(gastroesophageal reflux disease，GERD)、反流性食管炎(reflux esophagitis，RE)等计数指标比较采用χ2检验，P<0.05为差异有统计学意义。

结果

A组与B组的术后1、3个月RDQ评分分别为(13.83±5.09)分比(9.08±3.63)分、(13.16±4.97)分比(8.67±3.68)分。2组的术后1、3个月诊断为GERD的患者分别为9例比2例、10例比2例，经胃镜证实术后RE为A组7例、B组1例；术后RDQ评分B组均低于A组，差异有统计学意义(P<0.05)。2组术后RE及GERD发生率比较，B组明显低于A组，但差异无统计学意义(P>0.05)。

结论

腹腔镜辅助下Overlap法管型胃食管吻合较传统胃食管吻合具有更好的抗术后反流的疗效，且创伤小，操作简单安全，值得临床推广应用。

关键词: 近端胃切除, 食管胃结合部腺癌, Overlap法管型胃食管吻合, 腹腔镜辅助
Objective

To investigate the clinical effect of Overlap tube gastroesophageal anastomosis with laparoscopic assistance in Siewert typeⅡ and Ⅲ esophagogastric junction adenocarcinoma (AEG).

Methods

The clinical data of 30 patients with Siewert type Ⅱ and type Ⅲ AEG who underwent laparoscopic-assisted proximal gastrectomy from Jan. 2018 to Apr. 2020 in the Gastrointestinal Center, Subei People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, 18 cases of traditional esophagogastric anastomosis (group A) were performed before May 2019, and 12 cases of Overlap tube gastroesophageal anastomosis (group B) were performed in May 2019 and after. SPSS 19.0 statistical software was used for analysis. Measurement data such as general patient data, perioperative indicators and postoperative reflux questionnaire (RDQ) scores were expressed as ±s, and pairwise comparisons were performed by t test; postoperative gastroesophagus reflux disease (GERD), reflux esophagitis (RE) and other counting indicators were compared using the χ2 test, and P<0.05 was considered statistically significant.

Results

The RDQ scores of the traditional group and the tube stomach group were (13.83±5.09) points vs (9.08±3.63) points and (13.16±4.97) points vs (8.67±3.68) points at 1 month and 3 months after operation. The number of GERD diagnosed in the two groups at 1 month and 3 months after operation were (9 cases vs 2 cases) and (10 cases vs 2 cases). Gastroscopy confirmed that there were 7 cases of RE in the traditional group and 1 case in the tube-gastric group. Postoperative RDQ scores of patients in the tube-gastric group were lower than those in the traditional group, and the difference was statistically significant (P<0.05). In the comparison of postoperative RE and GERD incidence, the tube-gastric group was significantly lower than the traditional group, but the difference between the two groups was not statistically significant (P>0.05).

Conclusions

Compared with traditional gastroesophageal anastomosis, the Overlap tube gastroesophageal anastomosis with laparoscopic-assisted has a better effect on anti-reflux after surgery, and the traumat is relatively small, the operation is simple and safe, and it is worthy of clinical promotion.

Key words: Proximal gastrectomy, Adenocarcinoma of the esophagogastfic junction, Overlap tube gastroesophageal anastomosis, Assisted by laparoscopy
表1 30例近端胃切除术AEG患者的一般资料比较
组别 例数 年龄(岁， ±s) 体质量指数(kg/m2， ±s) 性别(例，男/女) TNM分期(例，Ⅰ/Ⅱ) 病理类型(例，Siewert Ⅱ型/Siewert Ⅲ型) 分化程度(例，低未/高中)
A组 18 65.06±6.40 23.29±3.18 10/8 11/7 9/9 5/13
B组 12 64.75±8.71 24.23±3.28 7/5 6/6 8/4 3/9
P值   0.913 0.439 >0.999 0.711 0.465 >0.999
表2 反流性疾病问卷表计分(分)
项目 胃烧灼感 反酸 反食 非心源性胸痛
频率        
  无 0 0 0 0
  <1 d/周 1 1 1 1
  1 d/周 2 2 2 2
  2～3 d/周 3 3 3 3
  4～5 d/周 4 4 4 4
  6～7 d/周 5 5 5 5
程度        
  无 0 0 0 0
  症状不明显 1 1 1 1
  症状轻微 2 2 2 2
  症状明显 3 3 3 3
  症状较重 4 4 4 4
  症状非常明显 5 5 5 5
表3 30例近端胃切除术AEG患者的围手术期指标( ±s)
组别 例数 手术时间(min) 术中出血量(ml) 术后活动时间(d) 术后排气时间(d) 术后进食时间(d) 术后住院时间(d)
A组 18 127.78±19.94 77.22±9.74 2.06±0.87 3.94±0.87 4.88±0.96 12.44±1.29
B组 12 153.75±15.69 76.25±13.34 1.58±0.79 3.67±1.07 4.42±0.79 11.92±1.56
t值   3.790 -0.231 -1.504 -0.778 -1.349 -1.007
P值   0.001 0.819 0.144 0.442 0.188 0.322
表4 两组不同消化道重建方式患者的术后反流情况[例(%)]
组别 例数 吻合口狭窄 胃食管反流病 反流性食管炎 Los Angeles分级
术后1个月 术后3个月 A级 B级 C级 D级
A组 18 4(22.22) 8(44.44) 9(50.00) 7(38.89) 0(0.00) 4(22.22) 2(11.11) 1(5.56)
B组 12 1(8.33) 2(16.67) 2(16.67) 1(8.33) 0(0.00) 1(8.33) 0(0.00) 0(0.00)
P值   0.622 0.235 0.121 0.099 >0.999 0.622 0.503 >0.999
表5 两组不同消化道重建方式患者的反流性疾病问卷表评分比较(分， ±s)
组别 例数 术后1个月 术后3个月
A组 18 13.83±5.09 13.16±4.97
B组 12 9.08±3.63 8.67±3.68
t值   -2.787 -2.678
P值   0.009 0.012
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